Week 3, Class 2 (9/15)

Question 1

Heart failure assessment findings

Answer 1

Tachycardia during rest and slight exertion
Tachypnea
Profuse scalp sweating
Sudden weight gain
Respiratory distress

Question 2

Heart failure considerations

Answer 2

Daily weights (Weight gain of 1lb in 24hr= fluid retention)
Monitor respirations and apical pulse
Monitor for facial or peripheral edema
Elevate HOB

Question 3

Heart failure nursing considerations cont.

Answer 3

• Administer digoxin, monitor for bradycardia and vomiting—> digoxin toxicity*
  -Dehydration can increase risk for toxicity
  Provide frequent rest periods, Cluster care
  Frequent small feedings
  Monitor for hypokalemia

Question 4

When do you withhold digoxin in pediatric patients?

Answer 4

If the pulse is < 90-110 in an infant or young child
Below 70 in an older child

Question 5

What to do if you miss a dose of digoxin?

Answer 5

If MORE than 4 hours have passed, Withhold the dose and give next dose at scheduled time
If LESS than 4 hours have passed, Administer the missed dose

Question 6

Types of Cardiac defects due to increased pulmonary blood flow

Answer 6

Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Atrioventricular canal defect
Patent ductus anteriosus (PDA)

Question 7

Atrial septal defect

Answer 7

Abnormal opening between the atria results in an increase flow of oxygenated blood into the right side of the heart

Question 8

Ventricular septal defect

Answer 8

Abnormal opening between the right and left ventricles

Question 9

Atrioventricular canal defect

Answer 9

Resulting from incomplete fusion of the endocardial cushions, often seen in children with down syndrome

Question 10

Patent ductus arteriosus

Answer 10

The fetal ductus arteriosus fails to close during the first weeks of life.
Machinery like murmur audible on auscultation
Widened pulse pressure and bounding pulses are present

Question 11

Medication given to close patent ductus arteriosus

Answer 11

Indomethacin, prostaglandin inhibitor

Question 12

Medication given to keep the patent ductus arteriosus open

Answer 12

Prostaglandin E

Question 13

Obstructive cardiac defects

Answer 13

Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis

Question 14

Coarctation of the aorta

Answer 14

Localized narrowing near the insertion of the ductus arteriosus

Question 15

Coarctation of the aorta findings

Answer 15

Blood pressure higher in the arms than in the legs
Coolness in the legs and weak femoral pulses
Headache, dizziness, fainting, epistaxis

Question 16

Aortic Stenosis

Answer 16

Narrowing or stricture of the aortic valve causes resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion.

Question 17

Aortic stenosis findings

Answer 17

Signs of decreased cardiac output: faint pulses, Hypotension, tachycardia, and poor feeding.
Exercise intolerance
Chest pain
Dizziness when standing for long periods of time

Question 18

Pulmonary stenosis

Answer 18

Entrance to the pulmonary artery is narrowed

Question 19

Pulmonary stenosis findings

Answer 19

Newborns with severe narrowing are cyanotic
Pulmonary atresia

Question 20

Types of Cardiac defects due to decreased pulmonary blood flow

Answer 20

Tetralogy of Fallot
Tricuspid Atresia

Question 21

Tetralogy of Fallot

Answer 21

Comprises four defects:
1) Ventricular septal defect
2) Pulmonary stenosis
3) Overriding aorta
4) Right ventricular hypertrophy

Question 22

Tetralogy of Fallot assessment findings

Answer 22

Acute to mild cyanosis
Acute episodes of hypoxia (hyper-cyanotic spells) “Blue spells or Tet spells”, Occurs when the infants oxygen requirements exceed blood supply
Squatting may be noted (shunts blood flow to the head)

Question 23

Tricuspid atresia

Answer 23

Tricuspid valve fails to develop, meaning that there is no communication between the right atrium and the right ventricle.

Question 24

Tricuspid atresia assessment findings

Answer 24

Mixing of unoxygenated and oxygenated blood in the left side of the heart result in systemic desaturation, pulmonary obstruction, and decreased pulmonary blood flow
Cyanosis, tachycardia, and dyspnea seen in affected newborn
Older children exhibit chronic hypoxemia and clubbing

Question 25

Mixed cardiac defects

Answer 25

Transposition of the great arteries/transposition of the great vessels, Total anomalous pulmonary venous connection, Truncus arteriosus, Hypoplastic left heart syndrome * all cause desaturation of systemic blood flow* 

Question 26

Transposition of the great arteries

Answer 26

Aorta and pulmonary arteries are switched No communication between the systemic and pulmonary circulations

Question 27

Transposition of the great arteries assessment findings

Answer 27

Cyanosis Cardiomegaly

Question 28

Transposition of the great arteries treatment

Answer 28

Prostaglandin E1 may be administered to temporarily increase blood mixing

Question 29

Total anomalous pulmonary venous congestion

Answer 29

Pulmonary veins fail to join the left atrium Mixed blood is returned to the right atrium and shunted from the right to the left through an atrial septal defect

Question 30

Total anomalous pulmonary venous congestion assessment findings

Answer 30

Right ventricle hypertrophy Cyanosis

Question 31

Truncus arteriosus

Answer 31

a single vessel that overrides both ventricles Causes desaturation and hypoxemia

Question 32

Hypoplastic left heart syndrome

Answer 32

Under development of the left side of the heart resulting in a hypoplastic left ventricle and aortic atresia Fatal in the first months of life without intervention

Question 33

Basic care and interventions for cardiac defects

Answer 33

Monitor for nasal flaring and use of accessory muscles (If respiratory effort is increased place child in reverse Trendelenburg position) *Monitor for hyper cyanotic spells* (if one occurs place infant in knee to chest position, administer 100% oxygen by facemask, and administer morphine sulfate and IV fluids as prescribed) Daily weights, Provide adequate nutrition (high calorie requirements)

Question 34

Rheumatic fever complication

Answer 34

Rheumatic heart disease which affects the cardiac valves, particularly the mitral valve

Question 35

When does rheumatic fever typically appear?

Answer 35

2 to 6 weeks after an untreated or partially treated group a beta-hemolytic streptococcal infection

Question 36

Rheumatic fever assessment findings

Answer 36

** Fever with history of sore throat**

Question 37

Rheumatic fever nursing considerations

Answer 37

Control joint pain and inflammation Administer antibiotics (penicillin) as prescribed Administer salicylates an anti-inflammatory agents Initiate seizure precautions Provide bedrest during the acute febrile phase

Question 38

Kawasaki disease

Answer 38

Acute systemic inflammatory illness that can lead to myocardial infarction. Unknown cause

Question 39

Acute stage Kawasaki disease assessment findings 

Answer 39

*Strawberry tongue* Conjunctival hyperemia Fever Swollen hands and rash Enlarged cervical lymph nodes

Question 40

Subacute stage Kawasaki disease assessment findings

Answer 40

Cracked lips and fissures Desquamation of skin on the tips of the fingers and toes (peeling) Joint pain Cardiac manifestations (Greatest risk for coronary aneurysm during the stage) 

Question 41

Convalescent stage Kawasaki’s disease assessment findings

Answer 41

Normal appearance but signs of inflammation may be present

Question 42

Kawasaki disease nursing considerations/treatment

Answer 42

*** Administer acetylsalicylic acid as prescribed for its antipyretic and anti-platelet affects*** *Administer immunoglobulin IV as prescribed to shorten duration of fever and reduce risk of coronary artery lesions and aneurysms. * Examine eyes for conjunctivitis Monitor mucous membranes for inflammation  Assess temperature frequently 

Question 43

When should hematology assessments/screenings be performed?

Answer 43

*Once during: Infancy (9–12 months of age) Childhood (1–5 years of age) Late childhood (5–12 years of age) Adolescence (14–20 years of age)

Question 44

What is a hematology assessment comprised of?

Answer 44

CBC History and physical exam Assessment of activity level Any bleeding Frequent infections Food diary Any comments the parents have regarding child

Question 45

Supportive care for RBC disorders

Answer 45

IV fluids to replace intravascular volume Oxygen therapy Bedrest

Question 46

Common hematologic disorders

Answer 46

Sickle cell anemia Iron deficiency anemia Hemophilia Beta-thalassemia 

Question 47

Pathophysiology of iron deficiency anemia

Answer 47

Iron deficiency anemia is caused by any number of factors that decrease supply or impair absorption of iron **“ Milk babies”, Common in 6–24 months, consuming greater than 32 ounces of milk per day**

Question 48

Iron deficiency anemia assessment findings

Answer 48

Pallor/paleness of mucous membranes Tiredness and fatigue PICA habit 

Question 49

Iron deficiency anemia nursing interventions

Answer 49

Administer ferrous sulfate (remember how to administer correctly) Encourage iron rich foods Provide frequent rest periods Support child’s need to limit activity

Question 50

Iron administration NCLEX hints

Answer 50

Give on an empty stomach (for better absorption) BETWEEN meals! Give with citrus juice (vitamin C for absorption) Use dropper or straw aimed at the back of the mouth to avoid discoloring teeth Teach that stools may become tarry  Teach that iron can be fatal overdosed, keep out of reach of children DO NOT give with any dairy products

Question 51

Hemophilia

Answer 51

Deficiency of specific clotting factors Inheritable pattern is X-linked recessive *Identification of a specific factor deficiency allows for definitive treatment*

Question 52

Hemophilia A

Answer 52

“ Classic hemophilia” Deficiency of factor 8 

Question 53

Hemophilia B

Answer 53

A.k.a. “ Christmas disease” Caused by deficiency of factor 9 

Question 54

Von Willebrand disease

Answer 54

Deficiency of Von Willebrand factor

Question 55

Hemophilia assessment findings

Answer 55

* Spontaneous bleeding into muscles and tissues and joint cavity (hemiarthrosis)* Loss of motion and joints Prolonged bleeding in the umbilical cord or injection sites Easy bruising and prolonged bleeding with minor trauma

Question 56

Hemophilia interventions

Answer 56

Teach local treatment for minor bleeds (RICE and splinting) Provide child with soft toys and use bedrails Have child wear medical alert bracelet Teach the importance of administration of clotting factor

Question 57

*** HEMOPHILIA NCLEX HINTS ***

Answer 57

Replace missing clotting factors -Aggressive replacement therapy with factor eight concentrate Desmopressin -IV administration or nasal spray -Causes 2 to 4 times increase in factor eight activity -Used for mild hemophilia Amicar (Aminocarproic acid) -Promotes clotting 

Question 58

Newborn sickle cell anemia

Answer 58

Newborns typically do not show symptoms at birth Fetal hemoglobin protects the red blood cells from sticking

Question 59

Sickle cell anemia interventions

Answer 59

**Keep child well hydrated** Avoid strenuous exercise Avoid high altitudes Seek care at first sign of infection *Do not withhold fluids at night due to enuresis*

Question 60

Sickle cell anemia vaso-occlusive crisis assessment findings

Answer 60

Absent/blocked blood flow to tissue causing hypoxia necrosis -fever -Severe abdominal pain - Painful edematous and feet -joint pain

Question 61

Sickle cell anemia interventions/treatment for vaso-occlusive crisis

Answer 61

**Provide intense hydration while maintaining fluid and electrolyte balance** * Pain medication: Adequate nursing care involves managing pain -Tylenol/ibuprofen (Mild) -Opioids; Morphine, Dilaudid (severe) Administer oxygen therapy as prescribed for hypoxemia Monitor intake and output Use caution with potassium replacement Promote rest